修正版Robson分类法对剖宫产率的趋势分析

目的描述河北省某市剖宫产的情况及其时间趋势,分析剖宫产的影响因素,为合理降低剖宫产率提供依据。方法调取河北省某县级市卫生统计信息网络直报系统中2015年1月—2017年12月期间15~49周岁育龄产妇住院分娩的病案首页数据12507份,剔除重复、死产、死胎等病例1043份,共11464份病例纳入本研究。应用修正版Robson法进行分类,按照孕周(妊娠≥37周、妊娠<37周)、产次(初产、经产,有无剖宫产史)、胎位(头位、臀位、横位或斜位)和胎数(单胎、多胎)等变量将所有产妇分为8组,分组计算剖宫产频数及构成比,计算组内剖宫产率和各组对总剖宫产率的贡献。修正版Robson分类的单胎头位足月初产妇组相当于经典分类中自然临产初产妇组与引产或临产前剖宫产初产妇组之和,单胎头位足月无剖宫产史经产妇组相当于经典分类中自然临产无剖宫产史经产妇组与引产或临产前剖宫产无剖宫产史经产妇组之和。结果共纳入3年内住院分娩的11464例孕产妇,平均剖宫产率为56.8%,2015—2017年剖宫产率55.5%~59.1%。应用修正版Robson分类发现,剖宫产构成比最高的是单胎头位足月有剖宫产史经产妇组(45.7%),其次是单胎头位足月初产妇组(33.5%)。单胎头位足月有剖宫产史经产妇组对总剖宫产率的贡献从2015年21.5%(95%CI:20.2%~22.9%)上升至2017年31.2%(95%CI:29.6%~32.7%),增长了9.7个百分点,是对总剖宫产率贡献的最大组(26.0%,95%CI:25.2%~26.8%)。单胎头位足月初产妇组对总剖宫产率的贡献排在第2位(19.0%,95%CI:18.3%~19.7%)。结论单胎头位足月有剖宫产史经产妇是对总剖宫产率贡献最大的人群,应在具备明确的适应症情况下,开展剖宫产后阴道分娩技术来控制剖宫产率的不合理增长。降低无医学指征的初次剖宫产,可消减未来有剖宫产史经产妇的分娩比例,对降低剖宫产率也具有重要的意义。

Trend analysis of cesarean section rate by modified Robson classification

Objective To describe the situation and time trend of cesarean section in a city of Hebei province,analyze the influencing factors of cesarean section,and provide a basis for reasonably reducing cesarean section rate.Methods From January 2015 to December 2017,data from the medical record home page of hospitalized childbirth of 12,507 women aged 15 to 49 years old were collected from the health statistics information network of a county-level city in Hebei Province.1,043 cases,including duplicate,stillbirth and dead fetus,were excluded,leaving 11,464 cases in the final analysis.According to modified Robson classification,all women were divided into 8 groups by gestational week(≥37 weeks gestation,<37 weeks gestation),parity(nulliparous,multiparous with or without history of cesarean section),fetal presentation(cephalic,breech,transverse or oblique),number of foetuses(single or multiple).The frequency and composition ratio of cesarean section were calculated by group,and the rate of cesarean section in the group and the contribution of each group to the total cesarean section rate were calculated.The single cephalic term nulliparous group based on the modified Robson classification was equivalent to the sum of the nulliparous group of natural labor and the nulliparous group of labor induction or caesarean section before labor,and the multiparous group of single cephalic term without cesarean section history was equivalent to the sum of the multiparous group with no history of cesarean section in natural labor and the multiparous group with no history of cesarean section in labor induction or caesarean section before labor.Results A total of 11,464 women who gave birth in hospital within 3 years were included,and the cesarean section rate from 2015 to 2017 was 55.5%-59.1%,with an average cesarean section rate of 56.8%.According to the modified Robson classification,the highest composition ratio of cesarean section was found in the multiparous women with single,cephalic,term,history of cesarean section(45.7%),followed by the nulliparous women with single,cephalic,term(33.5%).The contribution to the total cesarean section rate from the multiparous women with single,cephalic,term,history of cesarean section increased from 21.5%(95%CI:20.2%-22.9%)in 2015 to 31.2%(95%CI:29.6%-32.7%)in 2017,with an increase of 9.7 percentage points,which was the largest contribution to the total cesarean section rate(26.0%,95%CI:25.2%-26.8%).The contribution of the nulliparous women with single,cephalic,term to the total cesarean section rate was the second(19.0%,95%CI:18.3%-19.7%).Conclusion The multiparous women with single,cephalic,term,history of cesarean section is the largest population of contribution to the total cesarean section rate,indicating that a clear indication of vaginal delivery after cesarean section technology is needed to control the unreasonable growth of cesarean section rate.To reduce the first cesarean section without medical indications can reduce the proportion of delivery in the future with a history of cesarean section,which is also of great significance to reduce the cesarean section rate.